This research is generally developmental and applied in terms of results. In more detail, the type of study in the first objective is descriptive-library, in the second and third objectives are developmental, and the type of study in the fourth objective is descriptive. The study area is the general operating room of Namazi hospital which is affiliated whit Shiraz University of Medical Sciences. Research community were anesthesiologists, anesthesiologist assistants, and anesthetist nurses. Research sampling was not performed due to the limited size of the research population.

Determining the functional and non-functional requirements of the anesthesia module of the electronic medical file of the operating room department

The following four steps were carried out to determine the functional and non-functional requirements of the electronic medical record in the operating room department.

In the first stage, the researcher went to the operating room department of Namazi Medical Education Center and checked the existing forms of that center in connection with the registration of anesthesia information and extracted all the information elements recorded for the patients of this department.

In the second step, valid databases and all studies were reviewed, including articles, theses, reports, and guidelines in Farsi and English, without time limits.

In the third step, the researcher integrated the data elements and requirements (functional and non-functional) of the anesthesia module of the electronic medical record in the operating room section resulting from the first and second steps. Further, a complete and separate list of related items was prepared.

Designing the anesthesia module of the electronic medical record in the operating room section of the Namazi Medical Training Center of Shiraz University of Medical Sciences:

At this stage, the design of the anesthesia module of the electronic medical record in the operating room department was carried out in the following five steps:

Designing initial anesthesia form

The researcher designed all the data elements necessary for the anesthesia module of the electronic medical record in the operating room department, which was extracted from objective one, using Word and Photoshop as a five-page form. This form included identity information (demographic) and clinical information.

Identity information includes first name, last name, father's name, date of birth, height, weight, age, nationality, case number, gender, date of admission, date of anesthesia, and department of admission.

Clinical information includes 24 main groups: 1- Surgery information 2-Laboratory results 3-Patient graphs 4-Patient consultations 5-Consent letter 6-Physical examinations 7-Medication history 8-Family disease records 9-Social records 10-Past medical history, 11-Type of anesthesia 12-Anesthesia induction method 13-Airway management 14-Monitoring 15-Anesthesia chart, 16-Blood and fluids 17-Blood gases 18-Tourniquets and warmer 19-Accessories 20-Position 21-neuromascular reversal 22-Transfer patient from the operating room, 23- Complication of anesthesia 24-Seal and signature of the documenting physician and nurse anesthetist.

Evaluation of the initial form

The researcher held five focused group discussion sessions (1.5h) with a panel of experts, including three anesthesiologists working at Shiraz University of Medical Sciences and two experts in health information management, to evaluate the components of the initially designed form.

The prototype of the form designed in the operating room section of the Namazi therapeutic training center

After designing the prototype of the form, the specialists of the panel of experts agreed that the initial version of the form should be implemented in paper form for one week in the general operating room at the prayer therapy training center of Shiraz University of Medical Sciences. Then, the results are analyzed to ensure the quality of the prototype of the designed form in collecting anesthesia information required by the operating room department.

Preparation of data dictionary

A data dictionary is a collection of information about data that effectively helps others understand the meaning of data, describes the main information elements and structure of data, and serves as an index to identify all the data in the system. A data dictionary is a supplementary document that describes the information provided about data in detail and is the primary source of standard definitions for information elements and data structures in the system, including name, substitute, description, size and value, and unit [20].

At this stage, the researcher prepared the data dictionary, approved by the research team, and applied the experts' suggestions. The researcher and the anesthesiologists carefully reviewed the acceptable items for each information element and the acceptable range for each information element in preparing the data dictionary.

Scenario writing and review

The research team approved the scenarios prepared by the researcher. According to the experts’ opinion, things like mandatory registration of information about underlying diseases of the person, registration of tracheal tube type and its size, stylet type were added, and things like blind intubation and some laboratory results like AST/ALT, Acidosis, and Alkalosis were deleted. Finally, the scenarios were modified and approved.

Implementation of the anesthesia module of the electronic medical record in the operating room department of the prayer therapy training center of Shiraz University of Medical Sciences

The implementation of the anesthesia module of the electronic medical record in the operating room department was carried out in three steps:

Software programming

On November 3, 2022, the proposed plan, along with all the necessary documentation (including the data dictionary, scenarios, and the final sample designed from the paper form), was presented to the software designer team during a single session. The session lasted an average of two hours and was attended by the researcher and two anesthesiologists. After seven months, the programming team developed a prototype of the web application using React.js and Node.js programming languages. The team also used Mongo dB database and Windows server for data management.

Teaching the software to users

To train the users, the researcher began by compiling a list of all participants, which included three anesthesiologist assistants and twelve anesthesiologists. Three training sessions were then conducted at the users' workplace, located in the general operating room of Namazi Hospital. Each session lasted an average of two hours and covered instruction on how to use the module. During the training, the researcher was present in the operating room to address any questions or issues that arose while users were working with the system.

Aanesthesia module test of electronic medical records in the operating room department of Namazi Medical Training Center

In order to implement this module, two computers were used within the department. The software was then trialed for a week in the operating room department to identify any implementation issues and weaknesses. This trial allowed for the complete implementation of the system with minimal problems and obstacles. Throughout the trial, the researcher recorded any feedback, suggestions, or comments from doctors, assistants, and anesthesia experts. Following the trial, the programming team updated the software and resolved any reported problems or deficiencies.

Evaluation of the applicability of the anesthesia module of the electronic medical record in the operating room department of the Namazi Medical Training Center of Shiraz University of Medical Sciences

At this stage, the applicability of the anesthesia module of the electronic medical record in the operating room department was evaluated in the following two steps:

Distribution of evaluation questionnaire

To evaluate the applicability of the anesthesia module of the electronic medical record in the operating room department, the researcher utilized the USE standard questionnaire, which has been previously validated and tested for reliability [19]. The questionnaire consists of 30 questions, divided into four parts: usefulness (8 questions), ease of use (11 questions), easy learning (4 questions), and satisfaction (7 questions), all rated on a 7-point Likert scale from completely disagree to completely agree. An expert panel determined that 15 users of the anesthesia module in the operating room department would be sufficient for the evaluation. The researcher obtained permissions to distribute the questionnaire and explained the purpose of the evaluation to the users.

Analysis of the evaluation results

After distributing and collecting the questionnaires, the analysis of the collected data was done using the statistical software SPSS version 27.

It is worth mentioning that in this research, the medical records of patients were obtained from a teaching hospital where prior patient consent had been obtained for the use of their medical information for clinical and research goals. After the approval of the research ethics committee (IR.SUMS.NUMIMG.REG.1400.024), all the information of this research was collected and kept confidential. After distributing and collecting the questionnaires, the data were analyzed using the statistical SPSS software version 27.